Method and apparatus for coupling soft tissue to a bone

ABSTRACT

A method and apparatus for surgically repairing a tear in soft tissue is disclosed. A plurality of collapsible tubes are positioned about the suture. The collapsible tubes are pushed through soft tissue and orthopedic mesh on opposite sides of a tear in soft tissue. When tension is applied to the suture, the tubes are compressed to fix the suture to the soft tissue and draw the soft tissue portions together.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.12/489,168 filed Jun. 22, 2009, which is a continuation-in-partapplication of: (1.) U.S. patent application Ser. No. 12/474,802 filedon May 29, 2009, now U.S. Pat. No. 8,088,130 issued on Jan. 3, 2012;(2.) U.S. patent application Ser. No. 11/541,506 filed on Sep. 29, 2006,now U.S. Pat. No. 7,601,168 issued on Oct. 13, 2009; (3.) U.S. patentapplication Ser. No. 11/541,505 filed on Sep. 29, 2006, now U.S. Pat.No. 7,658,751 issued on Feb. 9, 2010; (4.) U.S. application Ser. No.12/014,390 filed on Jan. 15, 2008, now U.S. Pat. No. 7,909,851 issued onMar. 22, 2011; (5.) U.S. patent application Ser. No. 12/014,340 filed onJan. 15, 2008, now U.S. Pat. No. 7,905,904 issued on Mar. 15, 2011; (6.)U.S. patent application Ser. No. 11/935,681 filed on Nov. 6, 2007, nowU.S. Pat. No. 7,905,903 issued on Mar. 15, 2011; (7.) U.S. patentapplication Ser. No. 11/869,440 filed on Oct. 9, 2007, now U.S. Pat. No.7,857,830 issued on Dec. 28, 2010; (8.) U.S. patent application Ser. No.11/784,821 filed on Apr. 10, 2007; (9.) U.S. patent application Ser. No.11/347,661 filed on Feb. 3, 2006, now U.S. Pat. No. 7,749,250 issued onJul. 6, 2010; (10.) U.S. patent application Ser. No. 11/347,662 filed onFeb. 3, 2006, now abandoned; (11.) U.S. patent application Ser. No.12/196,405 filed on Aug. 22, 2008, now U.S. Pat. No. 8,128,658 issued onMar. 6, 2012; (12.) U.S. patent application Ser. No. 12/196,407, filedon Aug. 22, 2008, now U.S. Pat. No. 8,137,382 issued on Mar. 20, 2012;and (13.) U.S. patent application Ser. No. 12/196,410, filed on Aug. 22,2008, now U.S. Pat. No. 8,118,836 issued on Feb. 21, 2012.

The disclosures of the above applications are incorporated herein byreference.

FIELD

The present disclosure relates to method of coupling soft tissue to abone and, more particularly, to a method of implanting an ACL within afemoral tunnel.

BACKGROUND

The statements in this section merely provide background informationrelated to the present disclosure and may not constitute prior art.

It is commonplace in arthroscopic procedures to employ sutures andanchors to secure soft tissues to bone. Despite their widespread use,several improvements in the use of sutures and suture anchors may bemade. For example, the procedure of tying knots may be very timeconsuming, thereby increasing the cost of the procedure and limiting thecapacity of the surgeon. Furthermore, the strength of the repair may belimited by the strength of the knot. This latter drawback may be ofparticular significance if the knot is tied improperly as the strengthof the knot in such situations may be significantly lower than thetensile strength of the suture material.

To improve on these uses, suture having a single preformed loop havebeen provided. FIG. 1 represents a prior art suture construction. Asshown, one end of the suture is passed through a passage defined in thesuture itself. The application of tension to the ends of the suturepulls a portion of the suture through the passage, causing a loop formedin the suture to close. Relaxation of the system, however may allow aportion of the suture to translate back through the passage, thusrelieving the desired tension.

It is an object of the present teachings to provide an alternativedevice for anchoring sutures to bone and soft tissue. The device, whichis relatively simple in design and structure, is highly effective forits intended purpose.

SUMMARY

To overcome the aforementioned deficiencies, a method for configuring abraided tubular suture and a suture configuration are disclosed. Themethod includes passing a first end of the suture through a firstaperture into a passage defined by the suture and out a second aperturedefined by the suture so as to place the first end outside of thepassage. A second end of the suture is passed through the secondaperture into the passage and out the first aperture so as to place thesecond end outside of the passage.

A method of surgically implanting a suture construction in a femoraltunnel is disclosed. A suture construction is formed by passing thesuture through a bore defined by a locking member. A first end of thesuture is passed through a first aperture within the suture into apassage defined by the suture and out a second aperture defined by thesuture so as to place the first end outside of the passage and define afirst loop. A second end of the suture is then passed through the secondaperture into the passage and out the first aperture so as to place thesecond end outside of the passage, and define a second loop. The firstand second ends and the first and second loops are then passed throughthe femoral tunnel. Soft tissue is then passed through the first andsecond loops. Tension is applied onto the first and second ends toconstrict the first and second loops to pull the soft tissue into thetunnel.

In another embodiment, a method of surgically implanting a suture isdisclosed. The suture is passed through a bore defined by a firstfastener. A suture construction is formed by passing the suture througha bore defined by a locking member. A first end of the suture is passedthrough a first aperture within the suture into a passage defined by thesuture and out a second aperture defined by the suture so as to placethe first end outside of the passage and define a first loop. A secondend of the suture is then passed through the second aperture into thepassage and out the first aperture so as to place the second end outsideof the passage, and define a second loop. A second fastener is coupledto at least one of the first and second loops. After the fastener iscoupled to the patient, tension is applied onto the first and secondends to constrict at least one of the first and second loops.

In another embodiment a method of surgically implanting a soft tissuereplacement for attaching two bone members is disclosed. A first andsecond tunnel is formed in first and second bones. A locking memberhaving a first profile which allows insertion of the locking memberthrough the tunnel and a second profile which allows engagement with thepositive locking surface upon rotation of the locking member isprovided. The suture construction described above is coupled to thelocking member. The first and second ends and the first and second loopsof the construction and the locking member are threaded through thefirst and second tunnels. Soft tissue is threaded through the first andsecond loops so as to engage bearing surfaces on the first and secondloops. The locking member is then engaged.

Further areas of applicability will become apparent from the descriptionprovided herein. It should be understood that the description andspecific examples are intended for purposes of illustration only and arenot intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustration purposes only and arenot intended to limit the scope of the present disclosure in any way.

FIG. 1 represents a prior art suture configuration;

FIGS. 2A and 2B represent suture constructions according to theteachings;

FIG. 3 represents the formation of the suture configuration shown inFIG. 4A;

FIGS. 4A and 4B represent alternate suture configurations;

FIGS. 5-7 represent further alternate suture configurations;

FIG. 8 represents the suture construction according to FIG. 5 coupled toa bone engaging fastener;

FIGS. 9-11B represent the coupling of the suture construction accordingto FIG. 5 to a bone screw;

FIGS. 12A-12E represent the coupling of a soft tissue to an ACLreplacement in a femoral/humeral reconstruction;

FIGS. 13A-13D represent a close-up view of the suture shown in FIGS.1-11C;

FIGS. 14-16 represent fixed length textile anchors;

FIGS. 17-21 represent adjustable length textile anchors according to theteachings herein;

FIGS. 22-24 represent alternate adjustable length textile anchors;

FIGS. 25-27 represent alternate suture configurations;

FIG. 28 represents the preparation of the tibia and femur to accept theanchors disclosed in FIGS. 14-24;

FIGS. 29A and 29B represent the coupling of an ACL replacement in afemoral/tibial reconstruction using the textile anchor of FIG. 18;

FIGS. 30A and 30B represent the coupling of an ACL replacement in afemoral/tibial reconstruction using the textile anchor of FIG. 17;

FIGS. 31A and 31B represent the coupling of an ACL replacement in thefemoral/tibial reconstruction using the textile anchor of FIG. 15;

FIGS. 32A and 32B represent the coupling of an ACL replacement in afemoral/humeral reconstruction using the textile anchor of FIG. 16;

FIG. 33 represents a suture construction having a plurality ofcollapsible tubes;

FIGS. 34A-34C represent a tool used to surgically implant the sutureconstruction shown in FIG. 33;

FIGS. 35A-35C show the suture construction of FIG. 33 coupled to anorthopedic mesh;

FIGS. 36A-36C represent the use of an orthopedic mesh to repair a softtissue tear;

FIGS. 37A-39D represent various methodologies of coupling the sutureconstructions of FIG. 33 to soft tissue; and

FIGS. 40-45 represent an alternate suture construction.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, application, or uses. Itshould be understood that throughout the drawings, correspondingreference numerals indicate like or corresponding parts and features.

FIG. 2A represents a suture construction 20 according to the presentteachings. Shown is a suture 22 having a first end 24 and a second end26. The suture 22 is formed of a braided body 28 that defines alongitudinally formed hollow passage 30 therein. First and secondapertures 32 and 34 are defined in the braided body 28 at first andsecond locations of the longitudinally formed passage 30.

Briefly referring to FIG. 3, a first end 24 of the suture 22 is passedthrough the first aperture 32 and through longitudinal passage 30 formedby a passage portion and out the second aperture 34. The second end 26is passed through the second aperture 34, through the passage 30 and outthe first aperture 32. This forms two loops 46 and 46′. As seen in FIG.2B, the relationship of the first and second apertures 32 and 34 withrespect to the first and second ends 24 and 26 can be modified so as toallow a bow-tie suture construction 36. As described below, thelongitudinal and parallel placement of first and second suture portions38 and 40 of the suture 22 within the longitudinal passage 30 resiststhe reverse relative movement of the first and second portions 38 and 40of the suture once it is tightened.

The first and second apertures are formed during the braiding process asloose portions between pairs of fibers defining the suture. As furtherdescribed below, the first and second ends 24 and 26 can be passedthrough the longitudinal passage 30 multiple times. It is envisionedthat either a single or multiple apertures can be formed at the ends ofthe longitudinally formed passage.

As best seen in FIGS. 4A and 4B, a portion of the braided body 28 of thesuture defining the longitudinal passage 30 can be braided so as to havea diameter larger than the diameter of the first and second ends 24 and26. Additionally shown are first through fourth apertures 32, 34, 42,and 44. These apertures can be formed in the braiding process or can beformed during the construction process. In this regard, the apertures32, 34, 42, and 44 are defined between adjacent fibers in the braidedbody 28. As shown in FIG. 4B, and described below, it is envisioned thesutures can be passed through other biomedically compatible structures.

FIGS. 5-7 represent alternate constructions wherein a plurality of loopsare formed by passing the first and second ends 24 and 26 through thelongitudinal passage 30 multiple times. The first and second ends 24 and26 can be passed through multiple or single apertures defined at theends of the longitudinal passage 30. The tensioning of the ends 24 and26 cause relative translation of the sides of the suture with respect toeach other.

Upon applying tension to the first and second ends 24 and 26 of thesuture 22, the size of the loops 46 a-d is reduced to a desired size orload. At this point, additional tension causes the body of the suturedefining the longitudinal passage 30 to constrict about the parallelportions of the suture within the longitudinal passage 30. Thisconstriction reduces the diameter of the longitudinal passage 30, thusforming a mechanical interface between the exterior surfaces of thefirst and second parallel portions as well as the interior surface ofthe longitudinal passage 30.

As seen in FIGS. 8-11, the suture construction can be coupled to variousbiocompatible hardware. In regard, the suture construction 20 can becoupled to an aperture 52 of the bone engaging fastener 54.Additionally, it is envisioned that soft tissue or bone engaging members56 can be fastened to one or two loops 46. After fixing the boneengaging fastener 54, the members 56 can be used to repair, forinstance, a meniscal tear. The first and second ends 24, 26 are thenpulled, setting the tension on the loops 46, thus pulling the meniscusinto place. Additionally, upon application of tension, the longitudinalpassage 30 is constricted, thus preventing the relaxation of the tensioncaused by relative movement of the first and second parallel portions38, 40, within the longitudinal passage 30.

As seen in FIGS. 9-11B, the loops 46 can be used to fasten the sutureconstruction 20 to multiple types of prosthetic devices. As describedfurther below, the suture 22 can further be used to repair and couplesoft tissues in an anatomically desired position. Further, retraction ofthe first and second ends allows a physician to adjust the tension onthe loops between the prosthetic devices.

FIG. 11B represents the coupling of the suture construction according toFIG. 2B with a bone fastening member. Coupled to a pair of loops 46 and46′ is tissue fastening members 56. The application of tension to eitherthe first or second end 24 or 26 will tighten the loops 46 or 46′separately.

FIGS. 12A-12E represent potential uses of the suture constructions 20 inFIGS. 2A-7 in an ACL repair. As can be seen in FIG. 12A, thelongitudinal passage portion 30 of suture construction 20 can be firstcoupled to a fixation member 60. The member 60 an have a first profilewhich allows insertion of the member 60 through the tunnel and a secondprofile which allows engagement with a positive locking surface uponrotation. The longitudinal passage portion 30 of the suture construction20, member 60, loops 46 and ends 24, 26 can then be passed through afemoral and tibial tunnel 62. The fixation member 60 is positioned orcoupled to the femur. At this point, a natural or artificial ACL 64 canbe passed through a loop or loops 46 formed in the suture construction20. Tensioning of the first and second ends 24 and 26 applies tension tothe loops 46, thus pulling the ACL 64 into the tunnel. In this regard,the first and second ends are pulled through the femoral and tibialtunnel, thus constricting the loops 46 about the ACL 64 (see FIG. 12B).

As shown, the suture construction 20 allows for the application of forcealong an axis 61 defining the femoral tunnel. Specifically, theorientation of the suture construction 20 and, more specifically, theorientation of the longitudinal passage portion 30, the loops 46, andends 24, 26 allow for tension to be applied to the construction 20without applying non-seating forces to the fixation member 60. As anexample, should the loops 24, 26 be positioned at the member 60,application of forces to the ends 24, 26 may reduce the seating forceapplied by the member 60 onto the bone.

As best seen in FIG. 12C, the body portion 28 and parallel portions 38,40 of the suture construction 20 remain disposed within to the fixationmember 60. Further tension of the first ends draws the ACL 64 up throughthe tibial component into the femoral component. In this way, sutureends can be used to apply appropriate tension onto the ACL 64 component.The ACL 64 would be fixed to the tibial component using a plug or screwas is known. The suture construction has loops 46 and 46′ with a firstlength which allows rotation of the fixation member 60. Application oftension onto the ends 24, 26 of the sutures pulls the fixation member 60into position and the loops 46 and 46′ into a second length. In thisposition, rotation of the locking member in inhibited.

After feeding the ACL 64 through the loops 46, tensioning of the endsallows engagement of the ACL with bearing surfaces defined on the loops.The tensioning pulls the ACL 64 through a femoral and tibial tunnel. TheACL 64 could be further coupled to the femur using a transverse pin orplug. As shown in FIG. 12E, once the ACL is fastened to the tibia,further tensioning can be applied to the first and second ends 24, 26placing a desired predetermined load on the ACL. This tension can bemeasured using a force gauge. This load is maintained by the sutureconfiguration. It is equally envisioned that the fixation member 60 canbe placed on the tibial component 66 and the ACL pulled into the tunnelthrough the femur. Further, it is envisioned that bone cement orbiological materials may be inserted into the tunnel 62.

FIGS. 13A-13D represent a close-up of a portion of the suture 20. As canbe seen, the portion of the suture defining the longitudinal passage 30has a diameter d₁ which is larger than the diameter d₂ of the ends 24and 26. The first aperture 32 is formed between a pair of fiber members.As can be seen, the apertures 32, 34 can be formed between two adjacentfiber pairs 68, 70. Further, various shapes can be braided onto asurface of the longitudinal passage 30.

The sutures are typically braided of from 8 to 16 fibers. These fibersare made of nylon or other biocompatible material. It is envisioned thatthe suture 22 can be formed of multiple type of biocompatible fibershaving multiple coefficients of friction or size. Further, the braidingcan be accomplished so that different portions of the exterior surfaceof the suture can have different coefficients of friction or mechanicalproperties. The placement of a carrier fiber having a particular surfaceproperty can be modified along the length of the suture so as to placeit at varying locations within the braided constructions.

FIGS. 14-16 represent collapsible anchors 70, 72, 74 according to thepresent teachings. The anchors are deformable from a first cross sectionto a second engaging cross section. The anchors 70, 72, 74 arebiocompatible materials for example polymer or a knit or woven textilesuch as a braided nylon material. Disposed within a collapsible tube 76is a closed loop of suture material 78 which may form a portion of thecollapsible tube 76. Optionally, this collapsible tube 76 can beslidable with respect to the closed loop of suture material 78. Thecollapsible tube 76 is further collapsible to form a fabric mass 110(see for example FIG. 29B).

The suture material 78 can be passed through a pair of openings 83 inthe collapsible tube 76 a single time to form a single soft tissuebearing surface 80. Additionally, (see FIG. 15), the closed loop of thesuture material 78 can be looped over itself and passed through thecollapsible flexible tube 76 to form a pair of soft tissue bearingsurface portions 82. In each of the embodiments shown, the collapsibletube 76 defines at least one tube bearing surface.

FIG. 16 represents a closed loop of suture 78 passed through an aperture77 defined in a body 79 of the collapsible tube 76. In this regard, thesuture 78 is passed through a first open end 95 of the tube 78 andthrough the aperture 77 leaving a portion 81 of the collapsible tube 76which can be used to assist in the insertion of a graft to a patient(see FIG. 32A).

FIGS. 17-19 represent adjustable sized loops of suture material 78disposed within the collapsible tube 76 so as to form a suture anchorassembly 84, 86, 88. FIG. 17 shows the suture material 78 passed severaltimes through the collapsible tube 76. By applying tension to the ends90 and 92 of the suture material 78, the loops of the suture materialconstrict. If placed adjacent to a bearing surface (not shown), the end94 and 96 of the collapsible tube 76 are brought together, thuscollapsing the tube to form a collapsed material or fabric mass 110. Itis envisioned a portion of the suture material 78 can be passed throughthe collapsible tube 76 to help maintain the position of the suture withrespect to the collapsible tube 76.

FIGS. 18 and 19 show the loops of the suture construction of FIG. 4awithin a collapsible tube 76. The tubular portion of the construction ofFIG. 4a can be disposed either within or outside of the collapsible tube76. As with the embodiment shown in FIGS. 14-16, translation of the tube76 with respect to the suture material 78 can cause the ends 94 of thetube 76 to be brought together to compress the loops into a fabric mass110.

FIGS. 20 and 21 show the loops of FIGS. 2B, 4A or 5 disposed within thecollapsible tube 76. Shown are the ends and loops disposed at leastpartially through a portion 100 of the tube 76. Tensioning of the ends24, 26 causes the portions 100 of the tube 76 to collapse to form a mass110, while leaving other portions 85 uncollapsed. The outer uncollapsedportion 85 can function as a bearing surface to assist in the collapseof portion 100 when portion 100 is subjected to compressive loads.

FIG. 21 shows an embodiment where suture loops are passed through thesidewalls of the collapsible tube 76. Optionally, the loops 46 and 47 aswell as the ends 24 and 26 can be passed through together. Thisconstruction can be used in situations where a large collapsed mass 110is needed.

FIG. 22 shows the loop of FIG. 2B having a pair of collapsible tubes 76.The collapsible tubes 76 are disposed about the loops 46 and 46′ andwill collapse upon application of tension to the ends of the sutureconstruction in a manner which places compressive loads onto the ends ofthe tube 76. It is envisioned that these collapsible tubes 76 can becollapsed simultaneously or staggered in time as needed by a treatingphysician. It is also envisioned that the loop construction can be usedto pull adjacent portions of a patient's anatomy together.

FIG. 23 depicts the loop construction shown in FIG. 2A having its loopsdisposed through a pair of co-joined crossed collapsible tubes 76. Ifplaced adjacent to a bearing surface, the ends of the co-joined tubescome together, thus increasing in cross-section. This forms the fabricmass 110. This construction can be used in situations where a largecollapsed mass is needed.

FIG. 24 shows the complex suture construction which embodies a pair ofsuture constructions of FIG. 2A coupled together using a collapsibletube 76. The ends of the suture 22 can be passed though a pair ofpassages 30 and 30′ formed in the suture material 22. Portions of thesuture 22 are looped through each other to form a pair of locked loops112. This construction can be used to provide a static seat for a graftbearing surface.

FIGS. 25-27 represent alternate suture constructions where the ends ofthe sutures 22 are fed multiple times through holes 105 defined withinlongitudinal passage 30 of the suture to form adjustable loops 46. Insituations where relaxation of a tightened construction is to beminimized, the ends can be passed in and out of the passage 30 severaltimes. In this regard, the first and second ends are positioned so as tobe parallel and adjacent to each other in the passage 30.

FIGS. 26 and 27 represent constructions where the first and second ends24 and 26 a passed through the same passage 30, but do not overlap andare not adjacent. This construction may be useful for joining pairs ofmembers. This construction would be useful to bind pairs of appendagessuch as fingers.

FIG. 28 represents the formation of a femoral tunnel shown as a tunnel62 having a varying diameter. Disposed within either the femoral ortibial tunnel 62 are a first portion 102 having a first diameter and asecond portion 104 having a second diameter larger than the firstdiameter. Defined on an exterior surface of either the tibia or femur isa bearing surface 103, which is configured to interface with the fabricmass 110 of compressed textile material to prevent the relative motionof the fabric mass 110, and thus the suture construction with respect tothe bone. This bearing surface can be machined or natural.

FIGS. 29A and 29B represent potential uses of the suture construction 86in FIG. 18 in an ACL repair. As can be seen in FIG. 29A, thelongitudinal passage portion 30 of suture construction 86 can be firstcoupled to a collapsible tube 76. The tube 76 can have a first profilewhich allows insertion of the tube 76 through the tunnel 62 and a secondcross-sectional profile which allows engagement with a positive lockingsurface 103 upon collapse of the collapsible tube 76 into the fabricmass 110. The longitudinal passage portion 30 of the suture construction84, tube 76, loops 46 and ends 24, 26 can then be pulled through afemoral and tibial tunnel 62. The tube 76 is positioned or coupled tothe femur. At this point, a natural or artificial ACL 64 can be passedthrough a loop or loops 46 formed in the suture construction 20 or canbe supported by the passage portion 30. Tensioning of the first andsecond ends 24 and 26 applies tension to the loops 46 and 47 thuspulling the ACL 64 into the tunnel. In this regard, the first and secondends are pulled through the femoral and tibial tunnel 62, thusconstricting the loops 46 about the ACL 64.

After feeding the ACL 64 through the loops 46, tensioning of the endsallows engagement of the ACL with bearing surfaces defined on the loops.The tensioning pulls the ACL 64 through a femoral and tibial tunnel andcollapses the tube 76 to form a locking fabric mass 110 outside the boneor tunnel 62. The ACL 64 could be further coupled to the femur or tibiausing a transverse pin or plug. As shown in FIG. 29B, once the ACL isfastened to the tibia, further tensioning can be applied to the firstand second ends 24, 26 placing a desired predetermined load on the ACL.As described above, this tension can be measured using a force gauge.This load is maintained by the suture configuration. It is equallyenvisioned that the fixation member 60 can be placed on the tibialcomponent 66 and the ACL pulled into the tunnel through the femur.Further, it is envisioned that bone cement or biological materials maybe inserted into the tunnel 62. The longitudinal passage 30 resistsrelaxation or reverse movement of the suture.

As best seen in FIG. 29B, the body portion 28 and parallel portions 38,40 of the suture construction 86 remain disposed within the femoraltunnel 62. Further tension of the first ends draws the ACL 64 up throughthe tibial component into the femoral component. In this way, sutureends can be used to apply appropriate tension onto the ACL 64 component.The ACL 64 would be fixed to the tibial component using a plug or screweither before of after the application of the tension to the suture 22.Additionally, tension can be set on the ACL 64 after the collapsibletube 76 has been compressed.

FIGS. 30A and 30B represent potential uses of the suture constructions84 in FIG. 17 in an ACL repair. As can be seen in FIG. 30A, thelongitudinal passage portion 30 of suture construction 86 can be firstdisposed within the tube 76. The tube 76 has a first profile whichallows insertion of the tube 76 through the tunnel and a secondcollapsed profile which allows engagement with a positive lockingsurface 103. The collapsible tube 76 of the suture construction 84,member 60, and loops 46, 47 can then be passed through a femoral andtibial tunnel 62 using a suture 108. The tube 76 is positioned orcoupled to the femur. At this point, a natural or artificial ACL 64 canbe passed through a loop or loops 46, 47 formed in the sutureconstruction 84. Tensioning of the first and second ends 24 and 26applies tension to the loops 46, 47 thus pulling the ACL 64 into thetunnel. In this regard, the first and second ends 26 and 24 are pulledthrough the femoral and tibial tunnel, thus constricting the loops 46about the ACL 64 (see FIG. 30B) and collapsing the tube 76 to form theanchoring mass 110. Force applied to graft 64 along axis 61 in thedistal direction will seat tube 76 and form anchoring mass 110.

As shown, by holding the suture construction in place 108, the sutureconstruction 84 allows for the application of force along an axis 61defining the femoral tunnel 62. Specifically, the orientation of thesuture construction 84 and, more specifically, the orientation of thelongitudinal passage portion 30, the loops 46, and ends 24, 26 allow fortension to be applied to the construction 86 without applyingnon-seating forces to the tube 76. As an example, should the loops 24,26 be positioned at the tube application of forces to the ends 24, 26may reduce the seating force applied by the tube 76 onto the bone.

As best seen in FIG. 30B, the loop portions 46, 47 of the sutureconstruction 84 remain disposed within to the tunnel 62. Further tensionof the first ends draws the ACL 64 up through the tibial component intothe femoral component. In this way, suture ends can be used to applyappropriate tension onto the ACL 64 component. The ACL 64 would be fixedto the tibial component using a plug or screw 60 adjacent the sutureconstruction 84, as is known.

Alternatively, as shown in FIG. 30B, once the ACL is fastened to thetibia, further tensioning can be applied to the first and second ends24, 26 placing a desired predetermined load on the ACL. This load ismaintained by the suture configuration, it is equally envisioned thatthe fixation member 60 can be placed on the tibial component 66 and theACL pulled into the tunnel through the femur. Further, it is envisionedthat bone cement or biological materials may be inserted into the tunnel62.

FIGS. 31A and 31B represent potential uses of the suture construction 70in FIG. 14 in an ACL repair. The suture material 78 of sutureconstruction 70 can be first coupled to a collapsible tube 76. Thecollapsible tube 76 can have a first profile which allows insertion ofthe construction 70 through the tunnel and a second profile which allowsengagement with a positive locking surface 103 upon its compression.Prior to attachment to the femur, a natural or artificial ACL 64 can bepassed through a loop or loops 46 formed in the suture material 78.Suture construction 70 can then be passed through a femoral and tibialtunnel 62. The tube 76 is positioned or coupled to the femur. Tensioningof the first and second ends 112 and 114 of the soft tissue appliestension to the loop 76, thus collapsing the tube 76 to form the fabricmass 110. Tension can be applied to the soft tissue which can then befastened to the tibia using a fastener 60.

FIGS. 32A and 32B represent potential uses of the suture constructions74 in FIG. 16 in an ACL repair. The loop of suture 78 is coupled to acollapsible tube 76. The construction 74 can have a first profile whichallows insertion of the tube 76 through the tunnel and a second profilewhich allows engagement with a positive looking surface uponcompression. The suture portion 78 of the suture construction 74, tube76, and soft tissue 64 can then be passed through a femoral and tibialtunnel. The tube 76 is positioned or coupled to the femur 103 andcollapsed by the application of tension to the soft tissue 64.

As best seen in FIG. 32B, the anchoring mass 110 of the sutureconstruction 72 remains disposed outside the femoral tunnel. Tension isapplied to the ends of the ACL 64 up through the tibial component intothe femoral component. In this way, ends of the ACL 112, 114 can be usedto apply appropriate tension onto the ACL 64 component. The ACL 64 wouldbe fixed to the tibial component using a plug or screw as is known.

FIG. 33 represents a suture construction 100 according to the presentteachings. The suture construction 100 is formed of a suture 102 havinga plurality of collapsible tubes 104 disposed thereon. The collapsibletubes 104 can be knit suture material or a polymer tube. Formed on oneor both ends of the suture 102 can be a knot 106. Optionally, thecollapsible tube 104 can be coupled to the suture 102 using a stitch108, to prevent translation of the collapsible tube 104 with respect tothe suture 102.

FIGS. 34A-34C represent a tool 110 used to couple the sutureconstruction 100 with soft tissue. In this regard, the tool 110 has asharpened end 112 configured to pierce soft tissue 124. Disposedadjacent the sharpened end 112 is a recess 114 configured to support acollapsible tube 104. Disposed within the recess 114 is a collapsibletube holding member 116. This member 116 can be a flange or aretractable member which selectively engages the collapsible tube 104 tohold the collapsible tube within the recess 114. Disposed within thetool 100 actuatable member 118. The actuatable member 118 functions todeploy or deliver the collapsible tube 104 from the holding member 116of the recess 114. This generally occurs after the collapsible tube 104has been pressed through the soft tissue 124.

As shown in FIG. 34C, the sharpened end 112 can be pressed through softtissue 124, thus positioning the collapsible tube 104 on an obverse sideof the soft tissue 124. Application of force by the drive member 120onto the actuatable member 118 causes an engagable member 122 to deliverthe collapsible tube 104 from the recessed portion 114 of the tool 110.the engagable member 122 can be formed of Nitonol or can be pivotablycoupled to the actuatable member 118. At this point, the sharpened endcan be removed from the soft tissue 124, leaving the compressible tubeand its associated suture 102 therethrough.

As shown in FIGS. 35A-35C, multiple collapsible tubes 104 on the suture102 can be inserted through multiple apertures formed within the softtissue 124. Additionally shown is an implantable orthopedic mesh 130. Asbest seen in FIG. 35B, the sharp end 112 of the tool 110 can be fedthrough a single aperture 128 formed in a layer of soft tissue 120 suchas skin. The sharp end 112 is pressed through several apertures withinthe soft tissue 124 and through apertures within the implantableorthopedic mesh 130. The application of tensional force onto the suture102 allows the ends 131 of the collapsible tubes 104 to engage theorthopedic mesh 130. This allows the collapsible tube 104 to form a loopstructure locking the suture to the mesh 130. Further, the mesh iscoupled to the soft tissue 124, bone, skin, tendon, xenograft, allograftand autograft.

As best seen in FIG. 35C, once the collapsible tube 104 has beenpositioned through the orthopedic mesh 130, the needle is withdrawn toallow the engagement of the next collapsible tube 104 within the recess114 of the tool 110. The tool 110 is moved to position the sharp end 112in a desired location on the soft tissue 124. Pressure is then appliedto the tool 110 forming a hole within the soft tissue 124.

As described above, once the recess portion 114 is passed through thesoft tissue 124 or the orthopedic sports mesh 130, the actuator 118 canbe used to decouple the collapsible tube 104 from the recessed portion114. The sports mesh can be one sold by Biomet Sports Medicine as SportMesh™. This allows the removal of the tool 110 while leaving collapsibletube 104 and associated suture 102 on the obverse side of the softtissue 124 and the orthopedic mesh 130. The orthopedic mesh can beformed of resorbable materials.

As shown in FIGS. 36A-36C, the construction FIGS. 35A-35C and,particularly, the orthopedic mesh 130 can be used to repair torn softtissue 124. In this regard, it is envisioned the mesh 130 can be placedover a muscle tear 132. A series of collapsible tubes 104 are disposedover a suture 102 and can be coupled to the soft tissue by pushing thecollapsible tubes 104 through the soft tissue 124 and the mesh 130.Tension can be applied to the suture 102 to collapse the collapsibletube 104, thus coupling the sports mesh 130 to the two portions of softtissue 124 which are being repaired.

As best seen in FIGS. 36B and 36C, several different stitchingtechniques can be used to couple multiple collapsible tubes 104 alongthe periphery of the orthopedic mesh 130 on either side of a tear 132.The orthopedic mesh 130 functions to distribute loads along the muscle124, thus allowing the torn muscle 132 to heal properly.

As seen in FIG. 36C, sutures 134 can be added between the loops ofcollapsible tubes 104. It is envisioned that this functions to transferloads from one portion of the muscle to a second, thus allowing themuscle tear 132 to heal more rapidly and compress the tear 132.

FIGS. 37A-39D represent various methods of inserting the sutureconstructions shown above into soft tissue. FIGS. 37A and 37B representa collapsible tube having a single and double suture and constructions.These constructions are being threaded through a soft tissue 124, usinga speed pass suture retriever from Biomet Spots Medicine. A passage isformed within a soft tissue 124 using the speed pass suture retrieverhas a deployable portion which can grab a suture and pull it through thepassage. At this point, the suture construction having a suture 102 andcollapsible tube is positioned within the speed pass and pulled throughthe aperture formed within the soft tissue 124. Tension is applied tothe suture 102, thus collapsing the collapsible tube 104.

As seen in FIGS. 38A and 38B, by using a curved speed pass instrument, apair of apertures can be formed within the soft tissue. The speed passinstrument is then used to pull the suture construction through the twoapertures formed in the soft tissue 124. Alternatively, the sutureconstruction may be pressed within the speed pass 125 and released(pushed out) after the speed pass 125 has pierced the soft tissue.

As seen in FIGS. 38A and 38B, the speed pass having a corkscrew shapecan be used to form a pair of apertures in soft tissues which aregenerally perpendicular to the tool threading direction. In each ofthese conditions, tension is applied to the sutures 102 to compress thetubes 104. It is envisioned the speed pass can be used to feed thesuture constructions through the orthopedic mesh as described above.

FIGS. 40-45 represent a tool 140 used to couple the suture construction100 with soft tissue. In this regard, the tool 140 has a sharpened end142 configured to pierce soft tissue 124. Disposed adjacent to thesharpened end 142 is a first portion 144 configured to support acollapsible tube anchor 146. Adjacent to the first portion 144 is asecond portion 148 which can support a plurality of collapsible tubeanchors 146. Disposed between the first 144 and second portions 148 is agenerally conical portion 150. As shown in FIG. 41, the conical portion150 facilitates movement of the collapsible tubes 146 from the secondportion 148 to the first portion 144. Defined between the conicalportion 150 and the first portion 144 is a generally flat or planarsupport surface 152. The flat surface 152 is configured to support andapply axial forces to an end 154 of the collapsible tube anchor 146.

As best seen in FIG. 43, the conical portion 150 can have an oblongcross-section. This cross-section can facilitate the passing of thesuture through the soft tissue. The sharpened end 142 can be passedthrough soft tissue 124, thus placing the collapsible tube 146 on anobverse side of the soft tissue 124. At this point, the sharpened end142 can be passed through another soft tissue layer, a shorts mesh, orskin.

As shown in FIG. 45, the tool 140 can be withdrawn leaving thecollapsible tube 146 on the obverse side of the soft tissue. Force canthen be applied to the suture 156, as described above, to collapse thecollapsible tube 146.

The description of the invention is merely exemplary in nature and,thus, variations that do not depart from the gist of the invention areintended to be within the scope of the invention. For example, any ofthe above mentioned surgical procedures is applicable to repair of otherbody portions. For example, the procedures can be equally applied to therepair of wrists, elbows, ankles, and meniscal repair. The suture loopscan be passed through bores formed in soft or hard tissue. It is equallyenvisioned that the loops can be passed through or formed around anaperture or apertures formed in prosthetic devices e.g. humeral, femoralor tibial stems. Such variations are not to be regarded as a departurefrom the spirit and scope of the invention.

1.-12. (canceled)
 13. A suture anchor system, comprising: a sutureanchor assembly, comprising: a suture; and a collapsible anchor coupledto the suture, the collapsible anchor including a middle section, afirst end, and a second end; and an inserter carrying the suture anchorassembly, wherein said carrying includes the collapsible anchor in afolded delivery condition on a distal portion of the inserter with thesuture extending back from the collapsible anchor toward a proximal endof the inserter, wherein the collapsible anchor is collapsible from thefolded delivery condition to an anchoring condition inside a bone, thefolded delivery condition permitting advancement of the collapsibleanchor in a first direction through a tunnel formed in bone from a firstend of the tunnel toward a second end of the tunnel, the anchoringcondition forming an anchoring mass for contacting bone in the tunnelfor inhibiting movement of the collapsible anchor back through thetunnel in a second direction opposite the first direction, wherein thecollapsible anchor, in the folded delivery condition, includes thecollapsible anchor folded along the middle section of the collapsibleanchor such that, when the collapsible anchor in the folded deliverycondition is advanced through the tunnel in the first direction themiddle section can lead the collapsible anchor through the tunnel withthe first end and the second end of the collapsible anchor trailing themiddle section through the tunnel, wherein the collapsible anchor beingcoupled to the suture includes the suture: (i) passing entirely throughthe collapsible anchor at a first location between the first end and themiddle section of the collapsible anchor and again passing entirelythrough the collapsible anchor at a second location between the firstend and the middle section of the collapsible anchor; and (ii) passingentirely through the collapsible anchor at a third location between thesecond end and the middle section of the collapsible anchor and againpassing entirely through the collapsible anchor at a fourth locationbetween the second end and the middle section of the collapsible anchor.14. The suture anchor system of claim 13, wherein the distal portion ofthe inserter includes a recessed portion in which the collapsible anchorin the folded delivery condition is received.
 15. The suture anchorsystem of claim 13, wherein the collapsible anchor includes at least:(i) a first curved section and a second curved section between the firstend and the middle section of the collapsible anchor; and (ii) a thirdcurved section and a fourth curved section between the second end andthe middle section of the collapsible anchor.
 16. The suture anchorsystem of claim 15, wherein the first curved section and the secondcurved section curve in opposite directions along the collapsibleanchor, and wherein the third curved section and the fourth curvedsection curve in opposite directions along the collapsible anchor. 17.The suture anchor system of claim 13, wherein the collapsible anchor isformed entirely with a suture material.
 18. The suture anchor system ofclaim 13, wherein the collapsible anchor is formed entirely with a knit,woven, or braided material.
 19. The suture anchor system of claim 13,wherein the collapsible anchor comprises a tube.
 20. A suture anchorsystem, comprising: a suture anchor assembly, comprising: a suture; anda collapsible anchor coupled to the suture; and an inserter, thecollapsible anchor mounted on a distal portion of the inserter with thesuture extending back from the collapsible anchor toward a proximal endof the inserter, wherein the collapsible anchor being mounted on thedistal portion of the inserter includes the collapsible anchor foldedalong a middle section of the collapsible anchor with a first end and asecond end of the collapsible anchor extending back along the inserteraway from the middle section such that, when the collapsible anchor isadvanced through a bone tunnel, the middle section can lead thecollapsible anchor through the bone tunnel with the first end and thesecond end of the collapsible anchor trailing the middle section throughthe bone tunnel, wherein the collapsible anchor being mounted on thedistal portion of the inserter further includes the collapsible anchorexhibiting: (i) at least a first curved section and a second curvedsection along a first side of the collapsible anchor between the firstend and the middle section of the collapsible anchor; and (ii) at leasta third curved section and a fourth curved section along a second sideof the collapsible anchor between the second end and the middle sectionof the collapsible anchor, the suture passing entirely through thecollapsible anchor at least: (i) between the first curved section andthe second curved section; and (ii) between the third curved section andthe fourth curved section.
 21. The suture anchor system of claim 20,wherein the first curved section and the second curved section curve inopposite directions along the first side of the collapsible anchor, andwherein the third curved section and the fourth curved section curve inopposite directions along the second side of the collapsible anchor. 22.The suture anchor system of claim 20, wherein the collapsible anchorbeing mounted on the distal portion of the inserter includes the middlesection of the collapsible anchor being received in a recessed portionof the inserter.
 23. The suture anchor system of claim 20, wherein thecollapsible anchor is formed entirely with a suture material.
 24. Thesuture anchor system of claim 20, wherein the collapsible anchorcomprises a tube.
 25. A suture anchor assembly for anchoring suture tobone, the suture anchor assembly comprising: a suture having a firstfree end and a second free end; and a collapsible anchor having a firstanchor end and a second anchor end, the collapsible anchor received onthe suture with the first free end and the second free end of the suturelocated outside the collapsible anchor, the collapsible anchorcollapsible from a first condition to a second condition, the firstcondition of the collapsible anchor permitting advancement of thecollapsible anchor in a first direction through a tunnel formed in bonefrom a first end of the tunnel toward a second end of the tunnel, thesecond condition of the collapsible anchor forming an anchoring mass forcontacting bone in the tunnel for inhibiting movement of the collapsibleanchor back through the tunnel in a second direction opposite the firstdirection, wherein the collapsible anchor, when in the first condition,is folded along a middle section of the collapsible anchor so that whenthe collapsible anchor in the first condition is advanced through thetunnel in the first direction the middle section can lead thecollapsible anchor through the tunnel with the first anchor end and thesecond anchor end trailing the middle section through the tunnel,wherein the collapsible anchor, when in the first condition, includes:(i) a plurality of first anchor sections alternating with a plurality ofsecond anchor sections along a first side of the collapsible anchorbetween the first end and the middle section of the collapsible anchor,wherein each of the plurality of first anchor sections is occupied bythe suture, and wherein each of the plurality of second anchor sectionsis unoccupied by the suture and exhibits a curved shape; and (ii) aplurality of third anchor sections alternating with a plurality offourth anchor sections along a second side of the collapsible anchorbetween the second end and the middle section of the collapsible anchor,wherein each of the plurality of third anchor sections is occupied bythe suture, and wherein each of the plurality of fourth anchor sectionsis unoccupied by the suture and exhibits a curved shape.
 26. The sutureanchor assembly of claim 25, wherein the plurality of second anchorsections includes curved sections curving in opposite directions alongthe first side of the collapsible anchor, and wherein the plurality offourth anchor sections includes curved sections curving in oppositedirections along the second side of the collapsible anchor.
 27. Thesuture anchor assembly of claim 25 in combination with an insertercarrying the collapsible anchor in the first condition.
 28. The sutureanchor assembly of claim 27, wherein the inserter includes a distalrecessed portion in which the collapsible anchor in the first conditionis received.
 29. The suture anchor assembly of claim 25, wherein thecollapsible anchor is formed entirely with a suture material.
 30. Thesuture anchor assembly of claim 25, wherein the collapsible anchor isformed entirely with a knit, woven, or braided material.
 31. The sutureanchor assembly of claim 25, wherein the collapsible anchor comprises atube.
 32. The suture anchor assembly of claim 25, wherein the first freeend of the suture extends into the suture through a first opening in asidewall of the suture and back out of the suture through a secondopening in the sidewall of the suture to form an adjustable loop. 33.The suture anchor assembly of claim 25, wherein the collapsible anchoris formed entirely with a braided nylon.